Primary Healthcare
Conditions
Keywords
nurse-led discharge intervention, primary healthcare, cluster randomized controlled trail
Brief summary
The goal of this cluster randomized controlled trial is to evaluate whether a nurse-led primary health care (PHC) discharge intervention can improve patient activation and primary health care-related outcomes among hospitalized adult patients after discharge.
Detailed description
Chronic diseases account for approximately 74% of global deaths and remain the leading cause of morbidity and mortality worldwide and in Hong Kong, particularly ischemic heart disease, cerebrovascular disease, and diabetes-related complications. The growing burden of ageing populations and non-communicable diseases highlights the need to shift healthcare systems from secondary and tertiary care toward prevention-oriented primary health care (PHC). PHC serves as the first point of contact in a continuous healthcare process and is essential to a sustainable healthcare system. In response, Hong Kong is implementing a PHC reform through the establishment of District Health Centres to enhance population health and reduce pressure on public hospitals. Nurses, as the largest healthcare workforce, play a critical role in PHC delivery; however, nursing training in Hong Kong remains predominantly hospital-focused. Strengthening hospital nurses' roles in PHC-oriented discharge education may improve care continuity, patient self-management, and long-term health outcomes while reducing hospital readmissions and healthcare costs. The aims of study are as follows: 1. To determine the main effect of the Intervention vs. Control group on Patient Activation Measure at 3-month follow-up after discharge (Primary) 2. To assess the effects on secondary outcomes at 3-month and 6-month follow-ups 3. To identify mediators between intervention and outcomes to inform the potential mechanisms 4. To qualitatively explore subjects' perceptions of managing their own health conditions after leaving the hospital and their experience of following the primary healthcare discharge intervention suggested by nurses.
Interventions
BEHAVIORALPrimary healthcare discharge education
The primary healthcare discharge education begins by identifying priorities to address related to patients' life situations (using the Instrument for Patient Capacity Assessment) and determining the patient's current level of activation (using the Patient Activation Measure). A discharge education guide developed by the research team helps to individualize the teaching according to the patient's priorities and activation level.
BEHAVIORALspecially-designed health education leaflet
1. Introduction of the District Health Centres/Expresses; 2. Life Course Preventive Care Plan pamphlet; 3. Provide disease-specific discharge/rehabilitation advice and relevant health education materials with an emphasis on prevention and self-care management; 4. The hospital nurses will help discharge patients download and install the "HA Go" mobile app.
BEHAVIORALPatient discharge package
Subjects in the intervention group will receive the following items with instructions for use upon hospital discharge: 1. Blood pressure monitor 2. Blood glucose test strip 3. Soft ruler to measure weight circumference 4. Resistance bands for simple exercise
BEHAVIORALusual hospital discharge practice
The control group will receive the usual hospital discharge practice upon discharge.
Sponsors
The University of Hong Kong
Queen Mary Hospital, Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Hong Kong residents aged ≥18 years * Able to read and communicate in Chinese (Cantonese or Mandarin) * Being hospitalized for more than 24 hours * Stable medical condition upon hospital discharge
Exclusion criteria
* Having a history of psychiatric/psychological disease or currently on regular psychotropic medications * Currently participating in other primary healthcare programmes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The primary outcome is the change in the Patient Activation Measure (PAM) between baseline and 3-month follow-up. | From baseline to 3-month follow up. | The PAM is a 13-item self-report questionnaire to measure patient activation level \[18\]. Patients can go through four levels of activation: (1) disengaged and overwhelmed, (2) becoming aware but still struggling, (3) taking action, and (4) maintaining behaviors and pushing further \[18\].PAM raw score can be calculated by adding all of the responses to the 13 questions \[18\]. This score is then converted into an activation score ranging from 0 = no activation to 100 = high activation using a scoresheet provided by Insignia Health. |
Countries
Hong Kong
Contacts
CONTACTSiu Long Chau, PhD
PRINCIPAL_INVESTIGATORSiu Long Chau, PhD
HKU
Outcome results
None listed